INTRODUCTION: Trans Urethral Resection Syndrome is an important post operative complication of TURP posing therapeutic challenges due to wide Variety of presentation.
CASE PRESENTATION: A 60-year-old male was treated by the urology service for prostatic hypertrophy manifesting itself as urinary incontinence, urgency, and dribbling. Despite medical therapy the patient remained symptomatic. He was, therefore, scheduled for transurethral resection of the prostate (TURP). Preoperatively, the patient’s vital signs were normal. He was alert and oriented. His serum electrolytes and biochemical profile were normal. The patient underwent spinal anesthesia in preparation for the surgery. Intraoperatively the patient’s urinary bladder was irrigated with a 1.5 % glycine in sterile water solution but no intravenous fluids were administered. Approximately 45 minutes into the procedure the patient developed hypotension, nausea with vomiting, and confusion.The procedure was quickly terminated and the patient was transferred to the intensive care unit (ICU). There was an estimated blood loss of 200 cc during the procedure. His past history was significant for hypertension, hyperlipidemia, well-controlled insulin-dependent diabetes mellitus and diverticulosis. Upon arrival to the ICU the patient’s blood pressure was 82/46 mmHg, pulse 105 beats per minute, respiratory rate 16 breaths per minute. The patient was confused and was not oriented to person and time. His lung and cardiovascular examinations were normal. There were no focal or lateralizing neurological findings present. His initial serum glucose was normal but his serum sodium was 111 mEq/L. Conservative treatments with administration of intravenous normal saline at a rate of 200 cc/hour and discontinuation of his outpatient medications was initiated. The patient responded well to this modality of therapy. His mental status improved as his serum sodium returned to normal. Other causes of hyponatremia and hypotension such as SIADH, adrenal insufficiency, myocardial ischemia and hemolysis were ruled out.
DISCUSSIONS: TURP is one of the most frequently performed procedures in United States with 400,000 cases performed each year. This procedure is relatively safe and typically well tolerated. One serious complication, however, is transurethral resection syndrome (TURS).TURS occurs in 1.5-2% of patients undergoing TURP. TURS should be considered when the patient undergoing TURP becomes hypotensive and confused. Low serum sodium, in the absence of other disorders that cause hyponatrenia, confirms the diagnosis. The etiology of the hyponatremia is probably multifactorial .While our patient had a relatively benign clinical course, some patients suffer severe and life threatening complications. These complications include: permanent brain injury, myocardial infarction, and blindness. While TURS may be known to the practicing urologist, but internists and Intensivists may not be as well acquainted with this disorder.
CONCLUSION: We report this case to alert critical care physicians to this complication of a common urologic procedure.
DISCLOSURE: Abhijit Raval, No Financial Disclosure Information; No Product/Research Disclosure Information